Terminal care: present services and future priorities.

Since 1975 hospices and other specialist services for terminal cancer have expanded rapidly. In December 1980 this survey found 72 such services in Britain providing 58 inpatient units, 32 home care teams, and eight hospital support teams. Many were outside the NHS. Inpatient units provided 1297 beds (modal size 21-25 beds) and dealt with under 7% of deaths from cancer. Home care teams provided 76.5 full-time equivalent nurses (modal size two nurses). Regional variations were considerable: from 10.9 beds/million population in Trent to 48.5 beds/million in South-west Thames; no home care nurses in Mersey and Wales, and 5.1 nurses/million in Wessex. Of 58 more services being planned, the 17 starting in 1981 will not substantially alter these regional imbalances. Respondents'' opinions suggest a target of 40-50 inpatient unit beds/million population. This might be reduced if hospitals were better equipped to deal with these patients. Suggested priorities are to redress regional inequalities, develop home care and hospital support teams rather than inpatient units, and improve teaching and training. Co-ordination of plans between the NHS and the voluntary sector is needed.     

Transdisciplinary research and clinical priorities for better health

Modern medicine makes it possible for many people to live with multiple chronic diseases for decades, but this has enormous social, financial, and environmental consequences. Preclinical, epidemiological, and clinical trial data have shown that many of the most common chronic diseases are largely preventable with nutritional and lifestyle interventions that are targeting well-characterized signaling pathways and the symbiotic relationship with our microbiome. Most of the research priorities and spending for health are focused on finding new molecular targets for the development of biotech and pharmaceutical products. Very little is invested in mechanism-based preventive science, medicine, and education. We believe that overly enthusiastic expectations regarding the benefits of pharmacological research for disease treatment have the potential to impact and distort not only medical research and practice but also environmental health and sustainable economic growth. Transitioning from a primarily disease-centered medical system to a balanced preventive and personalized treatment healthcare system is key to reduce social disparities in health and achieve financially sustainable, universal health coverage for all. In this Perspective article, we discuss a range of science-based strategies, policies, and structural reforms to design an entire new disease prevention–centered science, educational, and healthcare system that maximizes both human and environmental health.

Luigi Fontana and co-authors discuss present and future challenges, and possible solutions, for global health and health care provision.

Environmental degradation, global warming, and rising pollution are impairing planetary health even as lifestyle- and age-related chronic diseases and emerging infectious diseases are devastating human lives. These are among the greatest challenges facing society today, since people are living longer but often not healthier lives. More than 65% of people over 65 years have 2 or more chronic diseases [1,2]. The current epidemic of obesity, beginning in children, is laying the foundation for even greater problems in the near future, including a reduction in healthy life expectancy. Governmental health expenditure as a percentage of gross domestic product is expected to more than double by 2050, making many existing health funding models unsustainable [3]. Additionally, the present medical approach to chronic diseases in the United States and other affluent countries has vast consequences on planetary health and global economic development. In brief, this reactive “sick-care” medical system is not efficient, equitable, or even viable. Similar problems are now affecting low-income countries, where the epidemiological transition to noncommunicable diseases is coupled with a still high incidence of infectious diseases, dramatic environmental dilapidation, lack of medical resources, and limited support for social and health promotion activities, resulting in increasing inequalities and poverty.     

Prospects for crop production under drought: research priorities and future directions

The efficient use of water supplies requires a systems approach that encompasses all aspects of making water available and its use within society that must recognise global issues. Increasing the efficiency of water use within agricultural systems is an essential priority in many regions including the Mediterranean. This review examines the research priorities, the prospects for crop and soil management and plant breeding and biotechnology that are needed to achieve high stable yield under drought in the Mediterranean. Research must combine the latest genomics resources including quantitative genetics, genomics and biomathematics with an ecophysiological understanding of the interactions between crop plant genotypes and the growing environment to better inform crop improvement.     

中国景观生态学发展历程与未来研究重点

景观生态学从其诞生到现在,已经历了70余年。中国景观生态学的发展从其引入,到发展、壮大、逐渐成熟,也经历了30余年。在这个发展过程中,中国景观生态学在跟踪国际前沿研究基础上,结合中国实际情况开展了大量研究,在许多研究领域取得了重要进展。简述了国际景观生态学会成立与发展过程,通过系统综述中国景观生态学文献,重点分析了中国景观生态学的发展历程;根据中国景观生态学研究特点,将中国景观生态学发展划分为五个阶段:摸索与酝酿阶段(20世纪80年代以前)、吸收与消化阶段(1980—1988年)、实践与迅速发展阶段(1989—2000)、发展与思索阶段(2001—2010)、思考与创新阶段(2011—?)。在此基础上,重点从土地利用格局与生态过程及尺度效应、城市生态用地与景观安全格局构建、景观生态规划与自然保护区网络优化、森林景观动态模拟与生态系统管理、绿洲景观演变与生态水文过程、景观破碎化与遗传多样性保护、多水塘系统与湿地景观格局设计、稻-鸭/鱼农田景观与生态系统健康、梯田文化景观与多功能维持、源汇景观格局分析与水土流失危险评价等方面系统分析了中国景观生态学研究的特点。最后从学科发展与理论研究、重点研究地区和应用实践三个方面分析了中国景观生态学未来发展的重点方向。     

Lepidoptera research in Puerto Rico: Reconnecting with historical legacies to guide future priorities

The Caribbean archipelago of Puerto Rico supports a diverse flora and fauna and is located in a region characterized by complex socio-economic and environmental change. The diversity of entomofauna across Puerto Rico has received considerable attention in wide-scale research over the last century, with particular emphasis on the order Lepidoptera as the subject of substantial taxonomic and ecological surveys. However, much of this work is incomplete, outdated, or has been obscured in gray literature. Thus, our primary objectives were to contextualize the role of past research in the current understanding of Puerto Rican Lepidoptera and to outline an agenda for future research. Specifically, we provide an overview of taxonomic, ecological, agricultural, and conservation Lepidoptera research in Puerto Rico and highlight key studies and historical datasets. We found that, despite a strong taxonomic legacy, native moth taxonomy remains poorly understood, except for a few major pests. Further, much of the recent Lepidoptera research has focused on short-term evaluations of agricultural pests, necessitated by immediate economic needs. The current ecological status of Lepidoptera on the islands is unknown. Therefore, prioritizing ecological research could provide timely insight for understanding changing Lepidoptera diversity and distribution and for conserving this biologically and economically significant group. Greater emphasis on long-term monitoring and digitization of museum collections would be particularly useful for quantifying past and forecasting future impacts of global change. Abstract in Spanish is available with online material.     

Dispersal of aquatic organisms by waterbirds: a review of past research and priorities for future studies

1. Inland wetlands constitute ecological islands of aquatic habitat often isolated by huge areas of non-suitable terrestrial habitats. Although most aquatic organisms lack the capacity to disperse by themselves to neighbouring catchments, many species present widespread distributions consistent with frequent dispersal by migratory waterbirds.
2. A literature review indicates that bird-mediated passive transport of propagules of aquatic invertebrates and plants is a frequent process in the field, at least at a local scale. Both endozoochory (internal transport) and ectozoochory (external transport) are important processes.
3. The characteristics of the dispersed and the disperser species that facilitate such transport remain largely uninvestigated, but a small propagule size tends to favour dispersal by both internal and external transport.
4. We review the information currently available on the processes of waterbird-mediated dispersal, establishing the limits of current knowledge and highlighting problems with research methods used in previous studies. We also identify studies required in the future to further our understanding of the role of such dispersal in aquatic ecology.     

Rice-maize systems of South Asia: current status, future prospects and research priorities for nutrient management

Rice (Oryza sativa L.) and maize (Zey mays) are grown in 3.5 million hectares (Mha) in Asia that includes 1.5 Mha in South Asia. These crops are grown in sequence on the same land in the same year either in double–or triple-crop systems to meet the rice demand of a rapidly expanding human population and maize demand of livestock and poultry. The objective of this review is to provide a comprehensive overview of the current state of technical knowledge on agro-ecosystems and adaptation, area and distribution, yield potential and yield gaps, and nutrient management for rice-maize (R-M) systems in South Asia. Rice-maize systems are emerging all around South Asia but in particular are developing quite rapidly in Bangladesh and South and North India. Yield potential of rice and maize, as estimated by ORYZA2000 and Hybrid Maize models, reaches up to 15 and 22 t ha^-1, respectively. However, data from several environments in India reveal gaps between potential and attainable yields of maize of upto 100% and between attainable and actual yields of upto 25–50%. Nutrient demand of R-M system is high due to high nutrient removal by high-yielding maize. Nutrient balance studies for these highly–productive and nutrient-extractive systems are scarce in South Asia. The review outlines principles of nutrient management for R-M systems, and identifies development, refinement, and dissemination of the integrated plant nutrition system technologies based on site-specific nutrient management principles as priorities for future research to increase yield, profitability, and sustainability of R-M systems.     

我国棉花种质资源研究现状及发展方向

棉花种质资源研究是一项基础性研究,最终目的是为育种者提供遗传多样性丰富的亲本材料.建国以来,我国在棉花种质资源收集方面取得了很大成绩,但几十年来用于种质资源研究的方法却举步不前,这与现代科学技术的迅速发展极不协调.根据种质资源研究现状以及当前生产需要,及时调整棉花种质资源工作的重点和方向,并将现代科学技术成果应用于种质资源研究是今后棉花种质资源研究发展的必然趋势.     

Older women's health priorities and perceptions of care delivery: results of the WOW health survey

BackgroundAs women get older, their health priorities change. We surveyed a sample of older Canadian women to investigate what health priorities are of concern to them, their perceptions about the care delivered to address these priorities and the extent to which priorities and perceptions of care differ across age groups and provinces.MethodsThe WOW (What Older women Want) cross-sectional health survey was mailed in October 2003 to 5000 community-dwelling women aged 55–95 years from 10 Canadian provinces. Women were asked questions on 26 health priorities according to the World Health Organization''s International Classification of Functioning, Disability and Health, and their perceptions of whether these priorities were being addressed by health care providers through screening or counselling. Differences in priorities and perceptions of care delivery were examined across age groups and provinces.ResultsThe response rate was 52%. The mean age of the respondents was 71 (standard deviation 7) years. The health priorities identified most frequently by the respondents were preventing memory loss (88% of the respondents), learning about the side effects of medications (88%) and correcting vision impairment (86%). Items least frequently selected were counselling about community programs (28%), counselling about exercise (33%) and pneumonia vaccination (33%). Up to 97% of the women recalled being adequately screened for heart disease and stroke risk factors, but as little as 11% reported receiving counselling regarding concerns about memory loss or end-of-life issues. Women who stated that specific priorities were of great concern or importance to them were more than twice as likely as those who stated that they were not of great concern or importance to perceive that these priorities were being addressed: osteoporosis (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.1–3.2), end-of-life care (OR 2.6, 95% CI 2.0–3.4), anxiety reduction (OR 2.2, 95% CI 1.8–2.6), fall prevention (OR 2.1, 95% CI 1.6–2.7), stroke (OR 2.1, 95% CI 1.4–3.0), depression (OR 2.1, 95% CI 1.7–2.7) and urinary incontinence (OR 2.1, 95% CI 1.7–2.5). The respondents'' perceptions of care delivery varied across age groups and provinces.InterpretationAccording to the perceptions of surveyed women, health care providers are addressing many, but not all, of their health concerns, especially those that are of great concern or importance to these women.As women''s life expectancy increases, physicians are confronted with the challenge of treating an elderly population that is predominantly female and has a variety of health priorities and needs. Older women face functional, psychological and social difficulties in addition to health-related conditions. One solution to align care more closely with women''s health priorities is to practise patient-centred care, whereby clinical decision-making is focused primarily on the priorities and preferences of individual patients.^1,2,3 Data on older women''s health priorities are scarce,^4,5,6 and understanding the gamut of their concerns is important for directing patient-centred, priority-driven agendas. The WOW — What Older women Want — health survey was conducted to determine health priorities of older Canadian women and the extent to which women perceive that their priorities are being addressed by health care professionals.